The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.
Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.
A program that puts the individual first
Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions. They are:
- Emphasize a personalized care experience
- Improve care for children and adults with complex behavioral health needs
- Improve wellness and health outcomes
- Support providers in better patient care
- Increase program transparency and accountability
UNLESS REQUIRED BY LEGISLATION OR UNION CONTRACT, STARTING SALARY WILL BE SET AT STEP 1 OF THE PAY RANGE
Office: Policy
Bureau: Health Plan Policy
Classification: Medicaid Health Systems Administrator 1 (PN 20087220)
Job Overview:
The Ohio Department of Medicaid (ODM) is seeking an experienced healthcare administrator to join the Policy Management and Development (PMD) team to assist with developing, implementing, and managing general provisions of the Ohio Medicaid program. This team is responsible for developing and implementing Ohio Administrative Code (OAC) rules that apply broadly such as those concerning provider agreements and credentialing, payment, coordination of benefits, program integrity, alternative payment models, telehealth, claim submission, prior authorization, electronic data interchange and national standards, and HIPAA compliant healthcare transactions. As a PMD healthcare administrator, your responsibilities will include:
- oversight of ODM’s provider credentialing policy including updates to Ohio Administrative Code (OAC), Medicaid state plan, and Medicaid Management Information System (MMIS)
- evaluating & assessing program needs & requirements for improving oversight and enforcement of general provisions
- completing updates to OAC rules and the state plan, managing the filing process, and implementing necessary changes across the agency to support operations
- ensuring policies comply with federal & state regulations, rules & laws
- assisting in the development and maintenance of the state MMIS
- evaluating and analyzing policies related to the design and regulatory oversight of general Medicaid provisions
- acting as a policy liaison and collaborating with other areas of ODM, sister state agencies, and/or external stakeholder groups
- communicating with stakeholders and developing instructional or educational materials to support implementation of programs and policies
- responding to inquiries from internal and external stakeholders
The preferred candidate will be detail-oriented, have strong critical thinking and problem solving skills, the ability to manage multiple priorities, and display great organizational and time management abilities.
Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a health services program or health services project management (eg, health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).
Or 12 months experience as a Medicaid Health Systems Specialist, 65293.
Note: education & experience is to be commensurate with approved position description on file.
- Or equivalent of Minimum Class Qualifications for Employment noted above.
